Journal of Dr. NTR University of Health Sciences

CASE REPORT
Year
: 2020  |  Volume : 9  |  Issue : 4  |  Page : 267--269

Intramedullary cysticercosis


J Suneeth1, Nimmagadda L Moorthy2, Gollapudi P Rao2, Doli M Chander2, N Anil Kumar2,  
1 Department of Radiodiagnosis, Gandhi Medical College, Secunderabad, Andhra Pradesh, India
2 Department of Neurosurgery, Gandhi Medical College, Secunderabad, Andhra Pradesh, India

Correspondence Address:
Dr. J Suneeth
Assistant Professor, Dept of Radiodiagnosis, ESIC Medical College, Hyderabad, Telangana- 500082.
India

Abstract

Neurocysticercosis is one of the most common parasitic diseases of the central nervous system. However, spinal involvement is rare. Here, we report the case of a 28-year-old man with intramedullary cysticercosis in the cervical spinal cord. Magnetic resonance imaging of the cervical spine with contrast showed a well-defined, peripherally enhancing intramedullary cyst at C3 spinal cord level producing significant perilesional edema with expansion of the cord. Because the patient had progressive neurological deficits, surgery was performed. Pathological examination of the removed lesion proved it to be cysticercosis..



How to cite this article:
Suneeth J, Moorthy NL, Rao GP, Chander DM, Kumar N A. Intramedullary cysticercosis.J NTR Univ Health Sci 2020;9:267-269


How to cite this URL:
Suneeth J, Moorthy NL, Rao GP, Chander DM, Kumar N A. Intramedullary cysticercosis. J NTR Univ Health Sci [serial online] 2020 [cited 2022 Dec 3 ];9:267-269
Available from: https://www.jdrntruhs.org/text.asp?2020/9/4/267/306131


Full Text



 Introduction



Taenia solium is the most common parasite causing central nervous system infections. However, spinal cysticercosis is rare, representing 1.2 to 5.8% of all cases of neurocysticercosis. It has been classified based on its location in the spine as extraspinal (vertebral) or intraspinal (epidural, subdural, arachnoid, or intramedullary). Among these, the intramedullary type is quite rare, with only 53 cases reported until 2010. Here, we report a case of intramedullary cysticercosis at the C3 vertebral level.

 Case Report



A 28-year-old man presented with chief complaints of neck pain since 2 years, difficulty in walking since 1 year, weakness since 6 months, and urinary incontinence since 3 months. On examination, he had spasticity in both upper and lower limbs with power 3/5.

Magnetic resonance imaging (MRI) of the cervical spine with contrast showed a well-defined peripherally enhancing intramedullary cystic lesion, hypointense on T1-weighted images (WI) and hyperintense on T2WI, of size 10 × 10 mm at the C3 spinal cord level producing significant perilesional edema with expansion of the cord [Figure 1],[Figure 2],[Figure 3],[Figure 4].{Figure 1}{Figure 2}{Figure 3}{Figure 4}

On surgery, the cyst was moderately vascular grayish in colour with calcification. Pathological examination revealed bits of tissue containing fibrocollagenous tissue with dense collections of lymphocytes, plasma cells, and eosinophils; cyst cavity contained the cut section of the cysticercous body cavity.

 Discussion



Involvement of spinal cord is a rare presentation of cysticercosis in endemic regions, with only 53 cases reported until 2010.[1] Though the common site of involvement is thoracic cord, it can also involve cervical and lumbar cords. The involvement of spinal cord is either by blood circulation or via ventriculo ependymal pathway.[2]

The clinical features[3] include pain, spasticity, paraplegia, incontinence of bladder and bowel, etc.

Imaging

On MRI, intramedullary cysticercosis shows the presence of a cyst which is hypointense on T1WI, hyperintense on T2WI (vesicular stage),[2] and hyperintense on T1WI and hypointense on T2WI (colloidal stage).[2] There can be peripheral enhancement,[4],[5] if cyst shows degeneration. Scolex within the cyst appears hyperintense on T1WI, and if present is diagnostic of the condition.

Differential diagnosis

Ependymal cyst, arachnoid cyst, neurenteric cyst, sarcoidosis, ependymoma, abscess. When a patient from an endemic area with a diagnosis of cysticercosis elsewhere presents with spinal cord cystic lesion, cysticercosis should be strongly suspected.

Although preoperative albendazole is an effective method of treatment, surgery was performed in the present case due to progressive neurological deficits.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kumar S, Handa A, Chavda S, Tiwari R, Abbey P. Intramedullary cysticercosis. J Clin Neurosci 2010;17:522-3.
2Qi B, Ge P, Yang H, Bi C, Li Y. Spinal Intramedullary Cysticercosis: A Case Report and Literature Review. Int J Med 2011;8:420-3.
3Sharma BS, Banerjee AK, Kak VK. Intramedullary spinal cysticercosis: Case report and review of literature. Clin Neurol Neurosurg 1987;89:111-6.
4Mathuriya SN, Khosla VK, Vasishta RK, Tewari MK, Pathak A, Prabhakar S. Intramedullary cysticercosis : MRI diagnosis. Neurology India 2001; 49:71-4.
5Parmar H, Shah J, Patwardhan V, Patankar T, Patkar D, Muzumdar D, et al. MR imaging in intramedullary cysticercosis. Neuroradiology2001;43:961-7.